Wait?! What?! My kid has CAVITIES?

If I wasn’t in the dental field, someone telling me my child has cavities would totally freak me out!  I understand, as a parent, that we are inundated with reasons to feel guilty about how we are raising our children.  The reality is that the number of kids with decay has been steadily increasing for decades and will affect most people at some point in their lives. 

Our office utilizes many tools to help flush out what can be changed at home or biologically to reduce the risk of future decay.  Our first step is to always figure out what you can start (or stop) doing at home to decrease future risk.  Sometimes it’s as simple as flossing a two-year-old for them because we see that the teeth are close together.  Sometimes it’s a more difficult battle like eliminating certain food and drinks from the diet. 

Reviewing homecare factors and individual factors (such as the pH of the mouth, the quality and quantity of saliva, and medications to name a few) will add or decrease from the baseline risk.  It is important in the initial diagnosis of decay that ALL potential reasons for decay are reviewed.  Let’s face it, treatment is just one aspect of the decay process.  Getting down to the reasons why and what we can do to mitigate that risk is just as, if not more, important.

The truth is, many factors may be responsible for why children are getting decay.  An important thing to consider is that if either parent has a history of decay and/or active decay (untreated areas of cavities), your child’s risk increases greatly.  Cavities are a communicable bacterial disease. 

Even though the initial cavity diagnosis can be harrowing, we will work with you in a judgment free zone to restore oral health and work with you to combat the disease as best we can to prevent future decay.  

Custom Mouth Guards - what does it mean?

Many sports either require a mouth guard, or while not required in others - it is often a very good idea!  One option to meet this need is a custom mouth guard.  While taking an impression for a custom mouth guard is a quick process, it may be an overwhelming new experience for some patients.  We continue our standard pediatric treatment techniques outlined by Amber in our April blog entry and make sure we explain the process through Show, Tell, Do.  Knowing what to expect should help ease any apprehension a patient may have, and choosing the thermoplastic material color for final mouth guard is a great way to start the half-hour appointment.  

The first step in creating your child's custom mouth guard is dry fitting the tray to be used in molding process.  We have a variety of sizes to ensure the best fit and the most comfortable process.  Once the appropriate size tray has been fit, dustless Jeltrate alginate powder is mixed with water to create the flexible, paste-like impression material.  There is a slight minty flavor and scent similar to toothpaste.  A small spatula is used to fill the impression tray before inserting it into the patient's mouth upper palate.  The upper lip will be lifted to ensure the tray is properly placed and not too far back to prevent gagging.

Your child's provider with hold the tray against upper palate until the alginate sets.  This only takes about 30-50 seconds.  Your child will need to hold still during the setting process so that consistent pressure can be maintained to ensure an accurate impression.  Once the tray and impression have been removed, no alginate is left on the teeth. For our patients with braces, wax will be placed over the orthodontic appliances prior to taking the impression to ensure no alginate becomes lodged.  The impression is inspected for imperfections caused by air bubbles, the tray not seated high enough on the upper gigival tissue above teeth, or movement during the setting process.  Sometimes an impression will need to be retaken, but not very often.

Below is a slide show of the full process - starring our own Dr. Scholl and her assistant Michelle!

In our lab, the impression is used to create a hard model of the teeth that will be used to make the final mouth guard.  Powdered dental stone is mixed with water and poured into the impression, still in the tray, to make a model of the upper teeth.  The dental vibration machine settles the dental stone into the details of the impression and reduces bubbles to create a smooth model.  The model has been poured, jiggled, and takes a few hours to dry before it can be removed from the tray and impression is disposed of.

The stone model must be smoothed on our model trimmer, a wet disc sander to reduce dust from the dental stone.  Once the model is trimmed and smooth, it is placed in the vacuum forming machine (the model used in this portion of the slide show is of Dr. Scholl's son).  The top section is the heat source that melts the thermoplastic sheet that was selected at the beginning of the impression process.  You can see the blue material Dr. Scholl's son chose clamped below the heat source.  The heat will cause it to soften to a drooping state at which the heat source is quickly moved to the side and the clamped thermoplastic can be slid down over the model.  The vacuum suction is engaged and the thermoplastic is sucked around the model to form the final mouth guard.  The plastic cools for a minute before it can be removed and the excess material is trimmed for a comfortable fit.

Store bought mouth guards certainly offer protection against dental trauma if they are formed correctly, but an accurate, professional impression of your child's teeth is the best protection they have with minimal additional investment over store bought options.  To schedule your athlete's impression, please call our Scheduling Coordinator at 607-4197 or inquire at your next oral health visit!

The Life of a Dental Instrument - Sterilization

Here at Coastal Maine Pediatric Dentistry our sterilization process is quite detailed. We thought you should know more about sterilization aside from the fact that instruments go in dirty and come out clean. Let me walk you through step by step what our instruments go through for each and every patient.

We have two separate sterilizing units, an ultraclave and a statim.  Every morning we run a Biological indicator (BI) through our ultraclave, A Biological indicator (BI) is the highest standard for sterility assurance. BI’s contain bacterial spores that test the lethality of sterilizers. The principle behind this is, if your sterilizer can effectively kill the highly resistant spores in the BI. Then we are confident it is capable of killing the less resistant organisms that could find their way onto our instruments. We mail in our BI’s every Monday after they are run through our ultraclave. Per CDC guidelines they need to be run at least once a week. Another monitoring system that we use is chemical indicators that monitor all steam sterilization processes. The indicator will turn dark brown to show that the contents are sterile. A chemical indicator goes in every statim cycle, along with being put into every wrapped cassette that goes in the ultraclave. At the start of the day one is run through both the statim and ultraclave to be kept for day to day monitoring consistency.

Dirty instruments and cassettes come into sterilization and are rinsed off and put into our Biosonic. The Biosonic is an ultrasonic cleaning process created by high frequency soundwaves. The soundwaves create high energy cavitation, cavitation being the formation of an empty space within a solid object or body. During cavitation millions of tiny bubbles form and then explode, releasing enormous amounts of energy and shockwaves. This powerful action reaches into the tiniest of crevices which cannot be reached by manual scrubbing. The combination of energy and specially formulated solutions makes ultrasonic cleaning the most effective method for removing microscopic debris.

After the instruments are done in the Biosonic they are taken out and thoroughly rinsed off before being put in the dryer. It’s important to dry the instruments after cleaning them because it cuts down the chance for instrument corrosion during sterilizing.

Once the instruments have finished the drying cycle they are either packaged or wrapped. Cassettes that go in the ultraclave get wrapped in a special cassette wrap with a chemical indicator on the inside. Loose instruments get bagged in sterilization pouches to be put in the statim. Before the lid to the statim closes we put a chemical indicator inside.

The statim’s unique steam injection technology allows the unit to be fast, compact, and reliable. The steam injection system eliminates 98% of the air in the sterilization cassette which helps achieve as close to hospital level sterilization as possible in an office setting. When the start button is pressed on the statim, the steam generator heats to the optimum temperature and distilled water is pumped in and converted to steam. A wall of steam is injected in to the cassette pressure chamber which has been loaded with the instruments that have now come out of the ultrasonic and been dried. Air is purged as the steam goes through the cassette and is continuously flushed into a waste bottle. After any cycle is completed the drying cycle switches on, rapidly drying and cooling the instruments.

The other sterilizer is the Ultraclave. The Ultraclave sterilizes the wrapped cassettes. Once you close the Ultraclave sterilizing chamber, air is forced out by pumping in steam. High pressured steam quickly raises the internal temperature. On every Ultraclave there is a thermometer that is waiting for the thermal point of 268-273 degrees Fahrenheit. Once that temperature is reached it starts its sterilizing timer. During the sterilizing process steam is continuously entering the Ultraclave thoroughly killing all dangerous microorganisms. Once the required time of sterilization is completed, the chamber will exhaust the pressure and steam allowing the door to open for cooling and drying.

Once all the instruments are sterilized they are put on drying racks where they will be picked up by hygienists or assistants for use.

Nicole - Dental Assistant

The Dreaded Information Update Sheet

The Importance of Updated Information

We are hyper aware that our information update sheet is something most parents wish they could skip.  We totally understand, and work really hard to make it a pain free experience.  We have structured it to avoid requesting information you have already provided.  At the same time, a lot can change between dental visits every six months, especially when it comes to growing children. We like to make sure we have up-to-date information regarding your child's health, habits, and insurance in order to provide the best care for your child and the most convenience for you.

Our office is happy to submit claims directly to your insurance as a courtesy to you.  Our hope is that by doing this on your behalf using our software specifically designed for the task and applying our expertise if the company raises a question, we relieve you from involvement in the claims process with your insurance company.  To do this we need the most up to date information.  When we do have the correct information we typically receive determination and/or payment within 2-3 weeks. In most cases our office will submit to your dental insurance for reimbursement, but in some situations, such as accidental injuries we may be able to bill to your medical plan if we are provided with the information needed. Correct information also prevents claim rejection which can result in unnecessary billing being sent to our patient families, which is never a pleasant surprise.

Some insurers like North East Delta Dental provide additional benefits for patients who are at high risk for dental caries or periodontal disease under a number of their plans. In cases where this wonderful benefit is available, we complete a Caries Risk Information Survey for your child to try to obtain any additional services available to help them achieve optimal health.  You can help us work with your insurer to determine whether your child is eligible for these additional preventive services by providing the updated information we request.  The answers you provide may qualify your child for services such as more frequent cleanings, fluoride treatments, and sealants per benefit period. Even if your insurer does not provide additional benefits, completing this information also guides your child's hygienist to focus their oral health education to the targeted areas where your child may need added encouragement and give us prompts to praise the wonderful work they are putting into their smiles. This also allows us to track your child's progress toward optimal nutritional and home hygienic habits.

In addition to nutrition and home health habits, we request information on your child's general well-being. Dental health can affect the whole child, and conversely, many factors outside the mouth can affect dental health. Stress, certain medical diagnoses, and changes to family structure, school behavior, and medication can all have an adverse effect on how teeth are cared for. Having insight into your child's well-being can help Dr. Scholl trouble shoot what may be causing a dental concern which will enable her to suggest the most conservative treatments and routines to best care for your child's oral health.

We look forward to seeing each and every patient in our practice, and we appreciate the time you put into your child's dental healthcare- including making sure we have the most up-to-date information.

Jess - Treatment Coordinator

Common Concerns and Questions

My child grinds her teeth and it's so loud!

Why are my kids teeth so yellow?

My kid has shark teeth.

My child often complains of his teeth being sensitive.

These are some of the most common concerns and questions we are faced with in pediatric dentistry. While these topics sound problematic, in most instances no action or intervention is required.  In this blog post, we’ll address them.

My child grinds her teeth and it’s driving me crazy!

We all cringe at the sound of crushing glass or nails running down a chalkboard.  Bruxism is the act of grinding or clenching the teeth together, and it may make a noise very similar to this.  Though the sound is what is most concerning with grinding, it is usually not evident on the teeth and unlikely to be causing any serious damage. Some causes of grinding are:

-Pain, teething, or ear infection.

-Physical pain, misalignment or overcrowding of the teeth between two arches.

-Stress or environmental change, school, divorce, death, or negative emotion.

We expect grinding to lessen between ages of 6 and 9 years and to stop between 9 to 12 years. If grinding has not stopped, or we begin to see too much damage to the teeth, we may suggest an over-the-counter or custom night guard.  A recommendation to visit the orthodontist will also be considered if appropriate.

I can not brush the yellow off!

There are many reasons for discoloration in teeth. The most common time parents ask about yellowing teeth is when the first permanent teeth begin to erupt.  The differing densities of tooth structure between the permanent and primary teeth often make the permanent teeth appear to be a fair bit yellow.  When compared to the bright white of primary teeth right next to the yellower permanent teeth, it’s obvious why there would be some concern!  Once baby teeth have all exfoliated the adult dentition is often a very normal shade of white.  Another cause for discoloration is a condition known as hypoplasia. This is a developmental defect often resulting in physically missing tooth structure or “mottled” enamel which has a brown or yellow hue to it. Hypomineralization is a decrease of mineral content in the enamel showing as bright white areas on the tooth surface.  While there are no specific known causes for hypoplasia/hypomineralization, some contributing factors may be infection or fever during pregnancy as primary tooth formation begins, premature birth, hereditary disorders, or some medications. Environmental factors would be trauma to a baby tooth causing disruption in formation of the adult tooth or systemic fluoride overingestion (fluorosis). In rare instances due to cosmetic concerns or tooth sensitivity, crowns, restorations (fillings) or sealants may be recommended.

Part child part shark you ask? 

Sometimes adult teeth will come in before their baby teeth fall out. This condition is known as ectopic eruption or "shark teeth" (the name given due to the double rows). Normally the adult tooth erupts under the baby tooth causing the baby tooth root to resorb, become wiggly, and fall out. If the permanent tooth erupts elsewhere it is usually due to inadequate space, and both primary and permanent versions are present at the same time. Most of the time no help is needed for the baby tooth to come out but we do encourage wiggling the baby tooth with clean hands. In some cases the dentist may need to extract the baby tooth.

Not being able to eat ice cream is no fun!  Tooth sensitivity can happen for a few reasons.  Often newly erupting permanent teeth can be sensitive to newfound exposures of air and foods. Fluoride treatment can help reduce the sensitivity.  Canker sores due to trauma such as cheek bites or acidity in the diet (juice, lemon, vinegar, fruit) can often be mistaken for tooth pain due to the child's inability to differentiate between the two.  Avoiding acidic foods and sodium lauryl sulfate (SLS foaming agent in toothpaste and mouth rinse) may decrease the recurrence rate of canker sores.  As previously mentioned hypoplasia is another cause of tooth sensitivity due to a disruption in the enamel formation which can expose the second layer of tooth called dentin.  Dentin is made of microscopic tubules with tiny nerves inside.  When these nerves are exposed to cold they can send a shock wave through the tooth. Tooth decay can also be a cause of tooth sensitivity in pediatric patients. When a cavity is just beginning to form a child may not experience any symptoms at all, but as the decay progresses they may experience sensitivity of mild to sharp pain when eating or drinking something sweet, hot or cold.  Routine dental care can help to diagnose smaller areas of decay before they do become sensitive.

Dr. Scholl and your child’s hygienist are here to help you. Please address any of your questions or concerns with them.

Erica - Hygienist

Is mouth rinse the answer?

“Kills germs that cause bad breath” (Listerine)

“For longer lasting fresh breath” (Colgate)

“Kids love it, cavities don’t” (ACT Kids)

“Healthy, beautiful smiles for life” (Crest)

Those are a few famous slogans from the most popular mouth rinse brands on the market today. Mouth rinses have always been a go-to supplementation to tooth brushing and flossing for fresher breath, a whiter smile and a cavity free dentition for decades. Per the American Dental Association, “Children under the age of 6 years should not use mouthwash, unless directed by a dentist, because they may swallow large amounts of the liquid inadvertently.”

Important components of mouth rinses are fluoride and pH. The fluoride ion incorporates into the biofilm of the teeth and helps to remineralize the tooth structure. pH is equally, if not more important, to the decay process.

Tooth structure will start to break down around a pH of 5.5, or what we consider the “danger zone”. When a person eats or drinks, the bacteria in the mouth secrete acid and bring the oral pH into the “danger zone”.  It typically takes 30 minutes for a person’s saliva to buffer against the acid attack, bringing the pH of the oral environment back to health. 

Similar to eating, when a person swishes with an acidic mouth rinse, the potential for an instant pH drop is present. The acidic liquid is being washed over all surfaces of the teeth, potentially keeping the oral environment in the “danger zone” longer than ideal. Our office has tested the pH of several over-the-counter mouth rinses: ACT, Listerine, Dr. Bite and Toms of Maine.  All resulted in a pH of 3-4, the “danger zone”. 

                                                     

(pH table listed from “Balance, a guide for managing dental caries for patients and                    practitioners” V.Kim Kutsch, DMD, Robert J. Bowers)

We furthered our research to find a basic mouth rinse called CXT3 Carifree Rinse, which we carry in our office and can also be found on Amazon.com. The pH of the Carifree rinse is neutral (8-9).  It also contains fluoride and xylitol. Xylitol is a natural sweetener, which has a 5-carbon sugar ring versus a 6-carbon sugar ring (like table sugar) therefore bacteria can not break it down and secrete acid.

Along with pH, there are many different risk factors that can contribute to and ultimately lead to decay. Diet (frequent drinks and snacking), medications that cause dry mouth, oral appliances (braces), medical history, family history, bacterial transmission, or the wrong home care routine are examples of how complex this disease process is. 

No patient is alike. We encourage you to have an in-depth conversation with your dentist and dental hygienist regarding any decay concerns. Our goal is to always work with our patients and their families to come up with a plan that works best for you, your family and ultimately keep the oral environment healthy and happy!

Sarah – Registered Dental Hygienist

(pH table listed from “Balance, a guide for managing dental caries for patients and practitioners” V.Kim Kutsch, DMD, Robert J. Bowers)

Tell-Show-Do, An Empowering Tool for Dental Health

Tell-Show-Do is a basic but important tool to help children feel comfortable in our office. We explain to the patient, step by step, what is about to happen as well as give them the opportunity to feel each tool first on an area of the body other than the oral cavity. For example, we will touch the patient’s fingernail with the explorer (“sharp instrument”) prior to touching the teeth, or we will allow the patient to hold the instruments themselves prior to use so that they can have a deeper understanding that our tools are safe and gentle. It is important for us to communicate in ways that the child will understand, so for our younger age groups we like to use more kid-friendly terms.  To make it fun and exciting, we may use the term Water Squirter, and replace the term “suction” with “Mr. Thirsty”, and “prophy brush” with “Tickle Toothbrush”.  As dental providers we firmly believe we need to earn the patient's trust by doing exactly what we have explained to the patient with no surprises.

As a Registered Dental Hygienist working in pediatrics, I find the Tell-Show-Do technique very valuable. One of the most common fears in young patients is a loss of control and by using this technique we are able to reduce patient anxiety for a more enjoyable visit.

In addition to Tell-Show-Do, we have a wide range of behavior guidance techniques to meet the needs of each individual child. Our distraction techniques are also very important to help relax an anxious child. Our reception area has a room especially made for your child to enjoy. The room contains I-Pads, books, puzzles, and a bead maze to help children unwind and take their minds off their appointment before they go to a treatment room. Once in the treatment room, we have Netflix ready for your child to pick their favorite show to watch during their exam. We provide headphones for them to listen, as well, which has the added benefit of blocking out background noise in the office.  Anything from the sound of our dental instruments to a vocal patient in a nearby room can be a distraction, so having headphones and a favorite show to focus on is a great tool to keep your child relaxed and content.

An extremely important factor in your child's success during an appointment is our consistent positive attitude.  This provides a happy environment regardless of the situation, day, or time. Above all, we have found that body language, tone of voice, and facial expressions play a very big role in reducing anxiety and encouraging patient cooperation. Consistent positive reinforcement is something we implement to help guide the child to have a good time during their appointment. At the end of every visit the patient earns a token they can use to pick a special prize from our prize tower.

From Beginning to end, we use our empowering tools and distraction techniques to provide a relaxing positive, and rewarding experience to ensure your child will enjoy their visit with us.

Amber - Registered Dental Hygienist